Provider Demographics
NPI:1699722884
Name:BREMNER, SANDRA MARION (FNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARION
Last Name:BREMNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOLCOMBE LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-8616
Mailing Address - Country:US
Mailing Address - Phone:843-997-0912
Mailing Address - Fax:888-979-8571
Practice Address - Street 1:8014 MYRTLE TRACE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-997-0912
Practice Address - Fax:888-979-8571
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1956363LF0000X
SCAA1260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1956OtherS.C. STATE LICENSE
SCNP1250Medicaid